Smoking is the leading behavioral risk factor for mortality globally, responsible for more than 175 million deaths and nearly 4.30 billion years of life lost (YLL) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies to achieve tobacco-free generations have recently been proposed, none have been implemented to date. This is the finding of the recent Global Burden of Disease analysis published in Lancet Public Health. Assessing what might happen if current trends in smoking prevalence persist and what might happen if further reductions in smoking prevalence occur is important for communicating the effect of potential policies on smoking.
The years of life lost
The world today faces complex and far-reaching health challenges. One of the most alarming indicators of these issues is years of life lost (YLL), a metric that measures years of life potentially lost due to premature deaths relative to average life expectancy at birth. This indicator directly reflects the impact of disease and premature death on populations.
In 2022, globally, 1020 million YLLs were lost among men and 757 million among women, with estimates indicating a further increase by 2050. In fact, YLLs are expected to reach 1040 million among men and 816 million among women by that year, leading to an impressive accumulated total of 52 billion YLLs between 2022 and 2050. This figure represents an unprecedented global health challenge.
However, an important aspect to consider is that the increase in YLL is largely attributable to the world’s growing and aging population. In fact, despite the absolute growth in the number of YLLs, age-standardized rates (which allow comparison of different populations taking into account differences in age structure) show a favorable trend, with an expected decrease in the overall rate of YLL. For men, the rate is expected to decline from 26,531 YLL per 100,000 people in 2022 to 17,113 in 2050; while for women, it is expected to decline from 18,919 YLL to 12,449 per 100,000 people. The Leading Causes of Lost Years of Life: The Burden of Non-Communicable Diseases
Most of the years of life lost will be the result of noncommunicable diseases (NCDs), which will account for a predominant share of YLLs. For women, it is estimated that NCDs will account for 68% of YLLs, while for men the proportion will be 64%. Cardiovascular disease and cancer will be the leading causes of premature deaths. Cardiovascular diseases are projected to lead to a cumulative total of 12 billion YLLs between 2022 and 2050, while cancers will cause 9 billion YLLs.
Non-communicable diseases, often associated with modern lifestyles and behavioral risk factors such as smoking, physical inactivity, poor diet, and alcohol consumption, continue to represent one of the greatest public health challenges, precisely because they are avoidable risk factors. Reducing the incidence of these diseases requires large-scale interventions that address both behavioral risk factors and social and health inequalities. The Impact Of Smoking: A Public Health Opportunity
Among avoidable risk factors, the most important in terms of disease burden and years of life lost is smoking. New estimates from the Global Burden of Diseases show that if smoking were completely eliminated in 2023, the world could avoid more than 2 billion YLLs between 2022 and 2050, with 1.7 billion avoidable YLLs among men and 341 million among women. The data presented here do not take into account new products (e-cigarettes and heated tobacco products) or secondhand smoke.
The regions of the world that would benefit most from this reduction in tobacco use are East Asia, with 708 million avoidable YLLs, and South Asia, with 385 million avoidable YLLs. In these areas, the prevalence of smoking and related diseases is particularly high, contributing to high rates of premature mortality. n Italy, 11 million YLLs could be avoided” (that’s 2.84 million for women and 8.14 for men).
Eliminating smoking would therefore represent a huge advance for global public health.
Should smoking elimination be delayed until 2050, it would still be possible to avoid 735 million YLLs among men and 141 million among women, but many of the benefits in terms of lives saved would not be seen until after 2040. This highlights the importance of acting early to maximize outcomes in terms of preventing premature deaths.
The major diseases that would contribute to avoidable smoking-related YLLs are cancers, ischemic heart disease, and chronic obstructive pulmonary disease (COPD), which together account for 85 percent of avoidable YLLs. Among cancers, lung cancer is particularly prominent, accounting for 63% of cancer-associated avoidable YLLs. Increasing Life Expectancy: A Positive Side Effect
Eliminating smoking would not only reduce years of life lost, but also have a significant impact on overall life expectancy. From 1990 to 2022, life expectancy at birth has already increased by about 8 years for both women and men. This trend is expected to continue, with life expectancy increasing to 76.1 years for men and 80.6 years for women by 2050.
If smoking were eliminated as early as 2023, global life expectancy would rise further, reaching 77.6 years for men and 81.0 years for women. This improvement would be particularly evident in regions such as East Asia, Eastern Europe and Central Asia, where men would see a gain of about 2.6 years of life. Women, especially in regions such as North America and Oceania, would also see a significant increase in life expectancy. In Italy, projected life expectancy in 2050 is 83.5 years for men and 87.0 for women. If smoking were eliminated in 2023, projected life expectancy in 2050 would grow to 84.5 years for men and 87.4 for women. The comment by Silvano Gallus, an epidemiologist at the Mario Negri Institute in Milan, is stark: “In light of these projections, one wonders how we can still tolerate the free circulation and sale of a product that causes disability and death for most of its consumers. What are we waiting for to abolish tobacco and nicotine, thus ending this veritable pandemic? It is frustrating and deeply saddening to see that the answer lies in the commercial interests of a few.”